Tattoo Consent Form

Tattoo Consent Form

Please complete the form to the best of your knowledge. Thanks!
Name:

First NameLast Name
Email:
example@example.com
Would you like to join up to my newsletter? They would be infrequent and contain offers of cancelled appointments, first look at flash and special offers.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of birth:

MonthDayYear
If you are under 25 please upload an image of your photo ID:

Cancelof
Phone Number:

Area CodePhone Number
Date of appointment:

MonthDayYear
Date
GP Surgery and address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
GP surgery phone number:

Area CodePhone Number
Short description of tattoo and placement:
Do you have any of the following medical conditions that may impact the treatment and healing of your tattoo? Please select all that apply.

Other
If yes to any of the above please add details here:
I cannot tattoo people with certain medical conditions however, for others may only require some adaptation. Please consult your GP if you have a medical condition before you come for your tattoo - they will be able to advise you better than I can, always best to get a thumbs up from them first!
Would you prefer a quiet appointment?
Preferred pronouns:
Do you consent for photos and/or videos of your tattoo to be taken? They may be shared in my online portfolio and can be completely anonymous (no identifying features/faces etc).
If the images are shared on Instagram, would you like to be tagged? If so please add your handle below.
Please read carefully the terms and conditions below. By ticking each box you are agreeing to abide by each statement.
Signature
Today's date:

MonthDayYear
Date
Should be Empty:

Tattoo Consent Form

Please read carefully the terms and conditions below. By ticking each box you are agreeing to abide by each statement.